Management of plantar heel pain: a best practice guide

NewsBot · Mar 30, 2021

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Management of plantar heel pain: a best practice guide informed by a systematic review, expert clinical reasoning and patient values
Dylan Morrissey et al
British Journal of Sports Medicine Published Online First: 30 March 2021.

Objective To develop a best practice guide for managing people with plantar heel pain (PHP).

Methods Mixed-methods design including systematic review, expert interviews and patient survey.

Data sources Medline, Embase, CINAHL, SPORTDiscus, Cochrane Central Register of Controlled Trials, trial registries, reference lists and citation tracking. Semi-structured interviews with world experts and a patient survey.

Eligibility criteria Randomised controlled trials (RCTs) evaluating any intervention for people with PHP in any language were included subject to strict quality criteria. Trials with a sample size greater than n=38 were considered for proof of efficacy. International experts were interviewed using a semi-structured approach and people with PHP were surveyed online.

Results Fifty-one eligible trials enrolled 4351 participants, with 9 RCTs suitable to determine proof of efficacy for 10 interventions. Forty people with PHP completed the online survey and 14 experts were interviewed resulting in 7 themes and 38 subthemes. There was good agreement between the systematic review findings and interview data about taping (SMD: 0.47, 95% CI 0.05 to 0.88) and plantar fascia stretching (SMD: 1.21, 95% CI 0.78 to 1.63) for first step pain in the short term. Clinical reasoning advocated combining these interventions with education and footwear advice as the core self-management approach. There was good expert agreement with systematic review findings recommending stepped care management with focused shockwave for first step pain in the short-term (OR: 1.89, 95% CI 1.18 to 3.04), medium-term (SMD 1.31, 95% CI 0.61 to 2.01) and long-term (SMD 1.67, 95% CI 0.88 to 2.45) and radial shockwave for first step pain in the short term (OR: 1.66, 95% CI 1.00 to 2.76) and long term (OR: 1.78, 95% CI 1.07 to 2.96). We found good agreement to ‘step care’ using custom foot orthoses for general pain in the short term (SMD: 0.41, 95% CI 0.07 to 0.74) and medium term (SMD: 0.55, 95% CI 0.09 to 1.02).

Conclusion Best practice from a mixed-methods study synthesising systematic review with expert opinion and patient feedback suggests core treatment for people with PHP should include taping, stretching and individualised education. Patients who do not optimally improve may be offered shockwave therapy, followed by custom orthoses.
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Craig Payne · Mar 30, 2021

Loading program/"rehab" did not make the cut!

scotfoot · May 10, 2021

"Loading program/"rehab" did not make the cut!"

Hi Craig
As far as I can make out, rehab of any strength deficits that might be caused by PHP /plantar fasciitis ,was not considered by the authors at all .
Happy to be corrected if I am wrong .

scotfoot · May 21, 2021

I get that they are saying that there was no level 1 evidence that rehab reduced pain .

What I am still not clear on however ,is, did the clinicians/researchers consider evidence around whether strength deficits were generally associated with PHP, and, if so, did they concluded if there was sufficient evidence to strongly link chronic PHP with intrinsic muscle weakness atrophy or not .

NewsBot · Jan 3, 2022

A Systematic Review of Systematic Reviews on the Epidemiology, Evaluation, and Treatment of Plantar Fasciitis
Hye Chang Rhim et al
Life (Basel). 2021 Nov 24;11(12):1287

The number of systematic review and meta-analyses on plantar fasciitis is expanding. The purpose of this review was to provide a comprehensive summary of reviews on the topic pertaining to plantar fasciitis, identify any conflicting and inconsistent results, and propose future research direction. A qualitative review of all systematic reviews and meta-analyses related to plantar fasciitis up to February 2021 was performed using PubMed, Embase, Web of Science, and the Cochrane Database. A total of 1052 articles were initially identified and 96 met the inclusion criteria. Included articles were summarized and divided into the following topics: epidemiology, diagnosis, and treatment. While the majority of reviews had high level of heterogeneity and included a small number of studies, there was general consensus on certain topics, such as BMI as a risk factor for plantar fasciitis and extracorporeal shockwave therapy as an effective mode of therapy. A qualitative summary of systematic reviews and meta-analyses published on plantar fasciitis provides a single source of updated information for clinicians. Evidence on topics such as the epidemiology, exercise therapy, or cost-effectiveness of treatment options for plantar fasciitis are lacking and warrant future research.
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NewsBot · Jan 5, 2023

Effects of therapeutic interventions on pain due to plantar fasciitis: A systematic review and meta-analysis
Janice de S. Guimarães et al
Source

Objective
To determine the effects of different therapeutic interventions that have ever been evaluated in randomized controlled trials on pain due to plantar fasciitis.
Methods
We searched different electronic databases until September 2022. Mean differences (MDs) and 95% confidence intervals (CIs) were calculated. The Grading of Recommendations Assessment, Development and Evaluation was used to evaluate the overall certainty evidence.
Results
A total of 236 studies met the study criteria, including 15,401 patients. Botulinum toxin MD −2.14 (CI: −4.15, −0.14), micronized dehydrated human amnion/chorion membrane injection MD −3.31 (CI: −5.54, −1.08), dry needling MD −2.34 (CI: −4.64, −0.04), low-dye taping MD −3.60 (CI: −4.16, −3.03), low-level laser therapy MD −2.09 (CI: −2.28, −1.90), myofascial releases MD −1.79 (CI: −2.63, −0.94), platelet-rich plasma MD −2.40 (CI: −4.16, −0.63), radiofrequency MD −2.47 (CI: −4.65, −0.29), and stretching MD −1.14 (CI: −2.02, −0.26) resulted in being effective treatments for pain when compared to the control in the short term. In the medium and long term, only extracorporeal shock wave therapy MD −0.97 (CI: −1.13, −0.81)/MD −2.49 (CI: −3.17, −1.82) was effective for improving pain when compared to the control.
Conclusions
Considering the available studies, this systematic review and meta-analysis showed that different therapeutic interventions seem to be useful strategies for improving pain in patients with plantar fasciitis. In the medium and long term, only extracorporeal shock wave therapy was effective in improving pain when compared to the control.
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NewsBot · Aug 7, 2023

Physiotherapeutic Interventions for Individuals
Suffering From Plantar Fasciitis: A Systematic
Review
Manali A. Boob Jr. , Pratik Phansopkar , Kamya J. Somaiya
Cureus 15(7): e42740. DOI 10.7759/cureus.42740

The foot and the lower leg comprise the ankle joint complex. The foot is crucial for the maintenance of
posture. Frequently, overuse or repeated microtrauma to the fascia causes plantar fasciitis. This review aims
to suggest the efficacy of various plantar fasciitis (PF) interventions based on modifications in clinical
results. This review included studies from 2019 to March 2023 identified through a systematic literature
search. The measures used to predict improvement in pain, discomfort, and foot function symptoms
included the Visual Analog scale, Numerical Pain Rating Scale, Pressure Point Threshold by algometer,
Weight-Bearing Lunge Test by inch tape, and range of motion. The review included 20 studies that fulfilled
the inclusion criteria. Therapeutic interventions included insoles, foot orthosis, foam roller stretching,
manual stretching, muscle strengthening, intrinsic muscle activities, extracorporeal shock wave lithotripsy,
dry needling, laser, ultrasound, and others, which resulted in pain reduction, improved foot function, and
ease of everyday routine. All therapeutic strategies used impacts resulting from minimal to maximal
recovery. Various advanced approaches are more effective than conventional physical therapy. In
conclusion, conservative therapeutic strategies with manual techniques, orthoses, and alternative
intervention strategies can be combined to effectively relieve pain and improve function and overall results.
Further high-quality studies are essential to learn more about the ideal dose, treatment approaches, and
long-term impacts of these therapies.
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NewsBot · Sep 8, 2023

Efficacy of pharmacological and non-pharmacological therapies on pain intensity and disability for plantar fasciitis: a systematic review and meta-analysis
Bianca Martins Lourenço et al
Br J Sports Med. 2023 Aug 24

Objective: To investigate the effects of pharmacological and non-pharmacological therapies on pain intensity and disability for plantar fasciitis.

Design: Systematic review of randomised controlled trials (RCTs).

Data sources: AMED, MEDLINE, PEDro, Cochrane, SPORTDiscus, CINAHL, EMBASE and PsycINFO without language or date restrictions up to 3 February 2023.

Eligibility criteria: RCTs that evaluated the efficacy of any pharmacological and non-pharmacological therapies compared with control (placebo, sham, waiting list or no intervention) on pain intensity and disability in people with plantar fasciitis. Two reviewers independently screened eligible trials, extracted data, assessed the methodological quality of included trials and assessed the certainty of the evidence using the Grading of Recommendations, Assessment, Development and Evaluations framework. Mean differences (MDs) with 95% CIs were reported.

Results: Seventeen different therapies investigated in 28 trials were included in the quantitative analysis. For non-pharmacological therapies, moderate certainty evidence showed short-term effects of customised orthoses on pain intensity when compared with control (MD of -12.0 points (95% CI -17.1 to -7.0) on a 0-100 scale). Low certainty evidence showed short-term effects of taping on pain intensity (-21.3 (95% CI -38.6 to -4.0)). Long-term effects and effects on disability are still uncertain. For pharmacological therapies, low to very low quality evidence from few trials with small samples was inconclusive and supports that high-quality trials are needed.

Conclusions: Moderate-quality and low-quality evidence demonstrates customised orthoses and taping, respectively, reduce pain intensity in the short term in patients with plantar fasciitis.
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NewsBot · Nov 9, 2023

Does the self-limiting condition of plantar fasciitis
necessitate intrusive management techniques?
Abhishek Kumar Mishra et al
PAMJ-CM - 13(1). 01 Sep 2023

Plantar fasciitis (PF), a multifactorial and selflimiting enthesopathy, is treated very differently by
each surgeon, and there is now substantial
research being conducted worldwide, primarily
focusing on invasive modes of management.
Indiscriminate use of invasive methods for the
treatment of PF is employed in poor nations like
India, both in rural and urban settings, placing
financial strain on patients and exposing them to
unneeded trauma. On the basis of a prospective
observational survey being done in our institute's
orthopaedics department, we recommend
adopting non-invasive, conservative therapeutic
techniques. A scoping review of publications on
various modalities of treatment of plantar fasciitis
was conducted in the PubMed database using
Mesh terms. Articles focusing on clinical trials were
shortlisted and data extracted. The data extracted
were tabulated. The author's recommendations for
the management of plantar fasciitis and the
algorithm formulated have been proposed
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NewsBot · Nov 20, 2023

Efficacy of pharmacological and non-pharmacological therapies on pain intensity and disability for plantar fasciitis: a systematic review and meta-analysis
Bianca Martins Lourenço et al
British Journal of Sports Medicine 2023;57:1516-1521

Objective To investigate the effects of pharmacological and non-pharmacological therapies on pain intensity and disability for plantar fasciitis.

Design Systematic review of randomised controlled trials (RCTs).

Data sources AMED, MEDLINE, PEDro, Cochrane, SPORTDiscus, CINAHL, EMBASE and PsycINFO without language or date restrictions up to 3 February 2023.

Eligibility criteria RCTs that evaluated the efficacy of any pharmacological and non-pharmacological therapies compared with control (placebo, sham, waiting list or no intervention) on pain intensity and disability in people with plantar fasciitis. Two reviewers independently screened eligible trials, extracted data, assessed the methodological quality of included trials and assessed the certainty of the evidence using the Grading of Recommendations, Assessment, Development and Evaluations framework. Mean differences (MDs) with 95% CIs were reported.

Results Seventeen different therapies investigated in 28 trials were included in the quantitative analysis. For non-pharmacological therapies, moderate certainty evidence showed short-term effects of customised orthoses on pain intensity when compared with control (MD of −12.0 points (95% CI −17.1 to −7.0) on a 0–100 scale). Low certainty evidence showed short-term effects of taping on pain intensity (−21.3 (95% CI −38.6 to −4.0)). Long-term effects and effects on disability are still uncertain. For pharmacological therapies, low to very low quality evidence from few trials with small samples was inconclusive and supports that high-quality trials are needed.

Conclusions Moderate-quality and low-quality evidence demonstrates customised orthoses and taping, respectively, reduce pain intensity in the short term in patients with plantar fasciitis.
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NewsBot · Feb 26, 2024

Plantar Fasciitis: An Updated Review
Wen-Che Tseng et al
J Med Ultrasound. 2023 Oct 6;31(4):268-274

Plantar fasciitis (PF) is a common musculoskeletal disease. Histologic findings of patients with PF showed mainly chronic degenerative processes rather than inflammation. In addition to mechanical factors, such as repetitive stress and reduced ankle dorsiflexion, PF is also linked to rheumatologic diseases and genetic factors. Ultrasound is becoming a standard imaging technique for assessing PF. Major sonographic findings included increased plantar fascia thickness and hypoechoic plantar fascia. In addition to traditional B-mode ultrasound, sonoelastography can also be utilized to diagnose PF. Ultrasound can also be used to guide therapeutic interventions. Over 80% of patients with PF improved under nonsurgical treatment. Treatment options for PF include physical therapy, modalities (laser, therapeutic ultrasound), extracorporeal shock wave therapy (ESWT), injections, transcatheter arterial embolization, and surgery. For injections, corticosteroid was mostly used in the past but has been replaced gradually by other techniques such as platelet-rich plasma or dextrose prolotherapy. There is also more and more evidence about ESWT in treating PF. Surgery serves as an option for recalcitrant PF cases, and endoscopic fasciotomy seemed to have good outcomes. Ultrasound plays an important role in diagnosing of PF and evaluating the treatment effect, and the use of sonoelastography in addition to traditional B-mode ultrasound may help in the early detection of PF and assessment of the treatment effect.
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Brian A. Rothbart · Feb 27, 2024

Plantar heel pain (Plantar Fasciitis) is a symptom. In order to eliminate this symptom, you must isolate and treat the cause. Otherwise, just treating the symptom will result in short term and disappointing results.

Assuming the heel pain is not due to trauma or inflammation, If the patient demonstrates gravity drive pronation, determine the cause of that abnormal pronation and the heel pain will most likely abate.

Brian A. Rothbart · Feb 27, 2024

NewsBot said: ↑

Plantar Fasciitis: An Updated Review
Wen-Che Tseng et al
J Med Ultrasound. 2023 Oct 6;31(4):268-274
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Appropriate insoles not included in this study!

scotfoot · Apr 20, 2024 at 11:43 AM

Has Morrissey et al 2021 author published retraction?

Ian Griffiths seems to be a popular figure in podiatry circles but gave me a hard time when I suggested Morrissey et al 2021 had gotten it wrong when they did not recommend foot strengthening for plantar fasciitis patients. It would appear he now agrees completely with my reasoning and point of view . Basically, when dealing with PF, include foot strengthening . It's unfortunate that this paper was published in the BJSM and had such resonance.

However, it takes character to admit you were wrong, so we move on.

Ian now says - " Despite this we know strengthening programmes/exercises are often being used in this cohort of patients. Regardless of the dearth of evidence to support this practice, perhaps it still actually sensible; there is data which suggests reduced muscle function, strength and size is associated with people with plantar heel pain compared to people without and improving muscle strength has been shown to be beneficial for other lower limb pathology" I wonder if Ian's fellow authors agree with his new point of view?

Management of plantar heel pain: a best practice guide informed by a systematic review, expert clinical reasoning and patient values
Dylan Morrissey et al
British Journal of Sports Medicine Published Online First: 30 March 2021.

scotfoot · Apr 23, 2024 at 8:02 PM

Strengthening Program for Planter Heel Pain

"Video accompanying Ian Griffith's review in the February 2024 issue of the Physio Network Research Reviews. The reviews are your shortcut to keeping up to date. Learn more here - https://www.physio-network.com/resear..."

I'm not sure if the 3 exercises illustrated in the video are the ones Ian uses for his plantar heel pain patients . The short foot exercise will certainly strengthen the foot but done to strict form it is -
1 difficult to learn
2 does not involve the plantar intrinsics which are all toe flexors

Calf raises have been found not to strengthen the intrinsics of the lesser toes and to make very little difference to the hallux strength even with a ramp ,a lot of load and a lot of effort.

If you want to strengthen muscles ,especially in older age groups ,then fatiguing them with progressive resistance exercise is, by far, the best option.

Management of plantar heel pain: a best practice guide

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Brian A. Rothbart Well-Known Member

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scotfoot Well-Known Member

scotfoot Well-Known Member

Management of plantar heel pain: a best practice guide informed by a systematic review, expert clini

Podiatrist vs GP management of plantar heel pain

Effectiveness of physical therapy treatment in addition to usual podiatry management of plantar heel

Chiropractors and Podiatrists views on the management of plantar fasciitis

Embedding pain neuroscience education in the management of plantar fasciitis

Topical sevoflurane: analgesic management in a marathon runner with plantar fasciitis

Use of Primary Corticosteroid Injection in the Management of Plantar Fasciopathy Is It Time to Chall

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Management of plantar heel pain: a best practice guide

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Craig Payne Moderator

scotfoot Well-Known Member

scotfoot Well-Known Member

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Brian A. Rothbart Well-Known Member

Brian A. Rothbart Well-Known Member

scotfoot Well-Known Member

scotfoot Well-Known Member

Management of plantar heel pain: a best practice guide informed by a systematic review, expert clini

Podiatrist vs GP management of plantar heel pain

Effectiveness of physical therapy treatment in addition to usual podiatry management of plantar heel

Chiropractors and Podiatrists views on the management of plantar fasciitis

Embedding pain neuroscience education in the management of plantar fasciitis

Topical sevoflurane: analgesic management in a marathon runner with plantar fasciitis

Use of Primary Corticosteroid Injection in the Management of Plantar Fasciopathy Is It Time to Chall

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